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🔢 Key Takeaways

  1. Through virtual consultations and daily conversations, Dr. Kurth managed Covid-19 symptoms, listened for complications, and provided reassurance. Virtual tools helped her stay focused and informed while preventing things from getting worse.
  2. Telehealth allows for safe and efficient non-emergency medical care from the comfort of home. While it may not be suitable for all health issues, it can provide increased access to care and reduce the risk of illness transmission.
  3. Telehealth has become more popular during the pandemic as a safer and more convenient way to receive medical care. While it offers benefits, there are concerns about delayed screenings and vaccinations as well as potential unintended consequences.
  4. Telehealth has various medical applications, including psychiatry, dermatology, and stroke care, and uses secure messaging for remote diagnosis and prescriptions. It's not limited to doctors and has the potential to transform modern healthcare.
  5. The US government's regulatory changes during the pandemic, including relaxed patient privacy rules and telehealth payments comparable to in-person visits, allowed for an unprecedented surge in telehealth and increased access to medical services, paving the way for a new era of healthcare.
  6. Telehealth experienced temporary regulatory changes during the pandemic, but its future is uncertain as it depends on political-economic decisions. Despite challenges with insurance coverage, the hope is that telehealth will continue to be reimbursed and utilized post-pandemic.
  7. Insurers were reluctant to reimburse for telehealth, but the pandemic changed that. With the uncertainty around deferred care and its impact on insurers, telehealth may become a new normal, or insurers may cut back reimbursements if utilization stays low.
  8. The Covid-19 pandemic has elevated the use of telehealth, and while it may decrease after the pandemic, it could still improve the system. Redesigning care and switching to telehealth visits could address pricing failures and inappropriate care, and the future of telehealth looks promising.
  9. Telehealth, a system that can improve convenience and accessibility, can lower costs by eliminating the need for staff and office space. Although it may not necessarily lead to cost savings, it does reduce the need for in-person clinical visits.
  10. Telehealth visits can help reduce costs, but may affect revenue. Providers worry about the absence of additional services. However, telehealth can prevent expensive hospitalization by using technologies for preventive care. Prevention is underdone, despite successful treatments for high cholesterol and hypertension being available for only about half of patients.
  11. Telehealth can enhance preventive care and manage chronic conditions, leading to better patient satisfaction and cost savings. Collaboration with technology partners can maximize its benefits, improving access, quality, and patient experience.
  12. Telehealth has the potential to revolutionize healthcare by providing more convenient and accessible options for patients. Proper implementation and careful research are necessary for better medical outcomes and could benefit those who struggle with traditional healthcare access.
  13. Telehealth may worsen existing disparities in healthcare, benefiting the wealthy and leaving lower-income groups without access to needed care. The costs vs. savings balance could also vary, but there is potential for technology to make healthcare more affordable and accessible.
  14. The cost of medical care is too high, and a full-frontal assault is necessary to reduce it. Patching up the A.C.A and costs while changing the payment model for doctors are essential steps towards efficient patient care.
  15. Providers can improve patient access and satisfaction by utilizing telehealth and alternative payment models. Opting out of insurance and prioritizing patient needs can lead to better overall outcomes.

📝 Podcast Notes

How Dr. Kurth Handled the Covid-19 Peak Virtually in NYC

Dr. Rebecca Kurth, an associate professor of clinical medicine, handled the Covid-19 peak in New York City by seeing patients virtually and by phone. She spent up to 30 minutes speaking with each patient each day, managing symptoms of the virus, listening for possible bacterial infections or other complications, and providing reassurance. Her virtual office provided quick access to her patients' health records, helped her stay focused on her tasks, and served as a reassuring background for video calls. While facing uncertainty, Dr. Kurth learned more about the illness to provide micro-interventions and prevent things from getting worse.

The Benefits and Limitations of Telehealth for Medical Care

Dr. Rebecca Kurth faced a dilemma when Covid-19 hit New York City: should she reopen her office or switch to telehealth? She decided on telehealth to keep her patients safe and realized it had many benefits. Patients enjoyed speaking from home, and it allowed Kurth to see more patients and diagnose minor problems, like low back pain. However, some health issues, like earaches or abdominal pain, require the doctor to physically examine the patient. Kurth believes telehealth will continue post-pandemic for certain types of care. Telehealth is an efficient and enjoyable way to receive non-emergency medical care, be seen more often, and avoid the risk of catching or transmitting an illness.

The Telehealth Revolution: The Shift to Virtual Medical Visits

The COVID-19 pandemic has led to a telehealth revolution, with more doctors and patients turning to telehealth visits for increased safety and convenience. This shift has led to a surge in telehealth visits, with some practices seeing a hundredfold increase. While there are concerns about long-term medical consequences due to delayed screenings and vaccinations, telehealth offers potential benefits, especially for those in rural or underserved areas. Regulatory changes and increased insurance coverage have also helped facilitate this shift. However, questions remain about who may be left behind in this revolution and what unintended consequences may arise. Overall, telehealth appears to be here to stay.

The Potential and Flexibility of Telehealth in Modern Healthcare

Telehealth has been around for a long time, with the earliest form dating back to the invention of the telephone in 1879. However, until the COVID-19 pandemic hit, take-up rates were low and less than 1% of Medicare patients used telehealth services. Telehealth can be used for various medical specializations, such as psychiatry, dermatology, and stroke care. It's not just video visits and telephone calls; e-visits and e-consults provide secure messages between patients and healthcare providers, allowing for remote diagnosis and prescriptions. Telehealth is not limited to doctors - nurses, clinical psychologists, and social workers can also use it. Rural hospitals without a full-time ICU, for example, can use tele-ICUs. Telehealth's flexibility shows that it has numerous applications and potential in modern healthcare.

Telehealth Surge in the US during COVID-19 Pandemic

The COVID-19 pandemic triggered a surge in telehealth in the US, where between 10 and 15 percent of medical visits are now conducted remotely. This unplanned telehealth surge was made possible by the Trump Administration's regulatory changes, including relaxed patient privacy rules and the allowance of remote consultations from home rather than medical facilities. Furthermore, the government made telehealth payments comparable to in-person visits, which was a significant incentive for providers. The relaxation of state licensure rules allowed practitioners to operate across state lines, which increased flexibility in providing medical services. David Cutler, a health care economist, sees this unprecedented development as an opportunity to increase access and cut spending, paving the way for a new era of telehealth.

The Future of Telehealth Post-Pandemic: Challenges and Opportunities

The pandemic brought about temporary regulatory changes that allowed for increased telehealth visits and waived co-pays, but these changes may not continue once the crisis is over as they depend on political-economic decisions. The biggest challenge faced by telehealth has always been the financial one, with fragmentation in insurance coverage leading to confusion among patients and providers. Money will likely determine the degree to which telehealth continues post-pandemic. Abuse of telehealth, however, is not a major concern, and the hope is that Congress will continue to reimburse telehealth visits as patients have shown an interest in using them and there have been no stories of widespread abuse.

The Ups and Downs of Telehealth Reimbursements by Insurers

Historically, C.M.S. has been disinclined towards reimbursing for telehealth due to a tendency to focus on where the hockey puck is and not where it's going. Private insurers had a bonanza because the use of medical services plummeted, but individuals and businesses who were writing them checks are unable to pay now. Although most insurers have been making a lot of money in the short term, they're wondering if the care deferred due to the pandemic will come back and bite them. If it does, insurers may need to impose more drug co-pays and stop telemedicine reimbursements. However, if utilization stays low, insurers will be in a much better position to accept telehealth as a part of routine care.

The Future of Telehealth in the US Healthcare System

The Covid-19 pandemic has accelerated the adoption of telehealth in the US healthcare system. While the spike in telehealth usage may drop after the pandemic, it will likely settle at a higher baseline level than pre-pandemic. Redesigning care and converting a significant share of in-person medical visits to telehealth visits (around 25%) could help improve the system and address two fundamental drivers of the broken, costly US healthcare system: pricing failures and inappropriate care. The future of telehealth is likely to be sticky, with providers and patients already investing time and energy in figuring out how to use it effectively.

The high cost of healthcare in the US and the potential solution with telehealth

The high cost of healthcare in the US is driven by administrative costs, higher prices of pharmaceuticals and physician visits, and more intensive medical care with unnecessary testing, hospitalization, and procedures. A system that is difficult to access and use also leads to poorer outcomes. Telehealth can improve convenience and accessibility, and lower costs by eliminating the need for staff and office space. While currently reimbursed at the same rate as in-person visits by C.M.S., telehealth visits can ultimately be done for around 85% of the cost of an in-person visit. However, some experts argue that telehealth may not necessarily lead to cost savings, but rather reduce the need for in-person clinical visits.

The Pros and Cons of Telehealth Visits: A Balanced View

Telehealth visits can reduce overhead costs but may also result in lower revenue due to payment equity and the absence of additional services offered during in-person care. The concern of healthcare providers is that telehealth visits may only offer essential services and not the low-value tests and procedures that providers currently make money from. However, telehealth can prove valuable in preventing expensive hospitalizations by using technologies for preventive care and healthcare monitoring. Prevention is currently underdone despite successful treatments for high cholesterol and hypertension being available for only about half of patients.

The Benefits of Telehealth and Its Potential to Improve Healthcare

Telehealth has the potential to increase preventive care by making regular activities easier to manage at home, such as taking medication or monitoring vitals. Remote monitoring and the use of artificial intelligence can aid in managing conditions like congestive heart failure and diabetes, while also improving patient satisfaction rates. Telehealth is part of a larger system of healthcare that should use information technology more effectively. By using telemedicine and partnering with companies like CVS and Walgreens, healthcare providers can improve lives and save money on conditions such as heart attacks and strokes while also focusing on access, quality, costs, and patient experience.

The Potential Impact of Telehealth on Cancer Diagnosis and Other Medical Outcomes

Remote monitoring has been successful in managing congestive heart failure and diabetes, but its population-level impact on cancer diagnosis and other medical outcomes is yet to be seen. Access to healthcare is crucial for better outcomes, and telehealth could be a more convenient and accessible option for those who struggle with traditional medical care. Telemedicine, if implemented properly, could revolutionize the way we care for patients and potentially keep them out of hospitals and inpatient settings. However, it could also lead to a power struggle for control over a patient's medical care. Further research and careful implementation of telehealth could lead to better medical outcomes, especially for those who struggle with traditional healthcare access.

The Inequality Risks of Telehealth in Healthcare

Telehealth may exacerbate existing inequality in healthcare by first benefiting those who are economically and demographically fortunate, while those in lower income groups may miss out on much-needed medications and screenings. Medical innovation always diffuses to higher-income people first, and the same may be true for telehealth. The winners may be physicians with more flexible schedules and patients who can receive care remotely, while losers may include office-support personnel and landlords of medical offices. The spending balance may increase or decrease depending on how much is spent on primary care relative to what is saved. While technology from telemedicine could potentially lower spending over time, there is a possibility of an increase in spending in the short run. Health-care systems are now open to change more than ever, making it a good time for the incoming administration to focus on priorities such as making healthcare accessible and affordable.

The Next President's Focus Should be on Medical Care

The next president, whether it is Biden or not, has to focus on medical care. The recession has left people without coverage, while the cost of medical care is too high. A full-frontal assault is necessary to address the administrative costs, wasted resource use, fraud and abuse, and prescription drug prices. The cost of medical care can be reduced by at least $1 trillion a year. The focus should be on patching up the A.C.A and costs instead of getting rid of private insurance and implementing Medicare-for-All. The fee-for-service system in most primary care needs to change to a payment model where doctors receive a set amount per person per month, adjusted for how ill they are, which encourages them to care for patients efficiently. The president has to address other issues too, not just medical care.

Leveraging Telehealth and Alternative Payment Models for Better Patient Care

Providers should consider using telehealth and email to see more patients and incentivize the use of telehealth through alternative payment models. Opting out of insurance can allow doctors to focus solely on the needs of their patients and become better doctors. Accepting all changes that benefit the patient's health should be a top priority for providers.